Using Fraser’s model of “progressive neoliberalism” to analyse deinstitutionalization and community care Cummins, ID http://dx.doi.org/10.1332/204986020X15783175560038 Title Using Fraser’s model of “progressive neoliberalism” to analyse deinstitutionalization and community care Authors Cummins, ID Type Article URL This version is available at: http://usir.salford.ac.uk/id/eprint/56312/ Published Date 2020 USIR is a digital collection of the research output of the University of Salford. Where copyright permits, full text material held in the repository is made freely available online and can be read, downloaded and copied for non-commercial private study or research purposes. Please check the manuscript for any further copyright restrictions. For more information, including our policy and submission procedure, please contact the Repository Team at: [email protected]. Using Fraser’s model of “progressive neoliberalism” to analyse deinstitutionalization and community care Abstract This article will argue that Nancy Fraser’s notion of “progressive neoliberalism” (Fraser, 2017, 2019) provides a conceptual lens that can be effective in the development of a critical analysis of mental health policy in England and Wales during the period of deinstitutionalisation and community care. Mental health policies that came steeped in an originally progressive discourse of choice, empowerment and wider service user rights were introduced by governments largely committed to free market. In the UK and the USA, this produced the contradictory position where moves community orientated vision of mental health service provision were overseen by administrations that were committed to a small state and fiscal conservatism. There were similar developments in other areas. Fraser (2017, 2019) terms this mixture of socially progressive rhetoric and market economics- progressive neoliberalism. Fraser’s model of progressive neoliberalism argues that neoliberalism has colonised progressive discourses. The paper outlines this theoretical model and then applies it to the development of community care. It argues that policy responses to the perceived failings of community care focused on increased powers of surveillance. This includes the introduction of legislation that allows for compulsory treatment in the community. The focus on legislation was at the expense of social investment. The paper concludes that the introduction of austerity in the UK has strengthened these trends. For example, The Coalition Government (2010-2015) introduced new mental health policies such as No Decision about me without me which emphasised inclusive approaches to service organisation and delivery. At the same time, it followed social and economic policies that increased inequality, reduced welfare payments and entitlement, and cut services.These are all factors that contribute to higher levels of mental distress across society. Key words : deinstitutionalization, neoliberalism, Fraser Introduction This paper outlines Fraser’s (2017, 2019) model of what she has termed “progressive neoliberalism”. This term captures the way that neoliberal political discourse has coopted terms from radical social movements. This process has meant that terms such as choice and empowerment have been used in very specific ways, within neoliberal discourse, to buttress individualism rather than to challenge structural inequalities. This article uses the development of mental health policies, particularly deinstitutionalization as a case study to examine the tensions between fiscal conservatism and social liberalism. It argues that fiscal conservatism and the development of the audit and inspection culture within public services became the dominant driver of mental health policy. These moves were combined with more coercive forms of mental health policy, which culminated in the introduction of Community Treatment Orders with the reform of the Mental Health Act (MHA) in 2007. This marks the end of official support for a policy of community care as envisaged by those who challenged the power of institutionalised psychiatry and asylums. Fraser’s model of “progressive neoliberalism” Garrett (2018) notes that neoliberalism is now a contested term. For some, it has become a concept that has lost genuine theoretical, conceptually or analytical value. Garrett (2018) notes that critics suggest that neoliberalism has become a meta narrative that can be used as an overarching explanation for all social problems. Neoliberal is such an elastic term that it is applied to the analysis of political and economic policies from Pinochet’s Chile to Deng Xiaoping’s China (Harvey, 2005). There is also a danger in the current approaches to policy analysis of a form of presentism that both ignores historical similarities and trends but also assumes that there was some sort of golden period before the arrival of Thatcher and Reagan and the political dominance of the Chicago School. Dunn (2017) notes that the term has most traction in academia and amongst “left elites”. Other writers have continued to find the term useful as an analytical tool. Bourdieu (2001) saw neoliberalism as a “conservative revolution” that sought to overthrow the postwar social democratic consensus.This required the extension of the market to all areas of life and the monetisation of human activity and relationships and the maximisation of profits (Harvey 2005, Brown (2015). Neoliberalism is, on its own terms, committed to a small state and personal freedom. Giroux (2011) highlights the way that neoliberal ideas have been able to set the agenda across social, political, economic and cultural fields. Bauman (2007) describes a culture of “hyperindividualism” which leads to a loosening and weakening of social and community ties. From the 1980s onwards, the role of the state has undergone a radical change. The expansion of the market or market mechanisms into a range of areas has seen the state become an equal player - in the jargon “a stakeholder” alongside others. One can thus see the overlaps between a philosophy committed to the reduction of the state and progressive ideas by focusing on individualism and choice identify the shortcomings and exclusionary nature of the post war social democratic welfare state. Fraser (2019) in her analysis of the rise of Trump and the outcome of the Brexit referendum argued that these shifts marked the end of what she termed“progressive neoliberalism”. She used this term to capture the processes whereby neoliberalism had coopted ideas that had originated in new social movements. These social movements, for example, the women’s and civil rights movements questioned and challenged fundamental societal structures.These different movements shared a core vocabulary of equality, individual freedom, respect and inclusive citizenship. Fraser (2017, 2019) argues that this language has been become a key feature of the discourse of late modern capitalism. As she argues that there is a disconnect between this discourse and the daily reality of late capitalist society where social protections have been swept away. Fraser (2019) suggests that these organisations and governments have used the language of social movements such as feminism and anti-racism - diversity, choice, empowerment whilst pursuing economic, political and social policies that contradict these core values. This can be seen in the way that huge global corporations such as Apple, Facebook and Amazon, present themselves as dynamic and committed to key issues such as diversity whilst at the same time engaging in anti-social behaviour such as selling private data and avoiding paying corporate tax. The Blair and Clinton administrations were the leaders in this shift. Fraser (2017) concludes that “Clinton was the principal engineer and standard-bearer of the “New Democrats,” the U.S. equivalent of Tony Blair’s “New Labor.” In place of the New Deal coalition of unionized manufacturing workers, African Americans, and the urban middle classes, he forged a new alliance of entrepreneurs, suburbanites, new social movements, and youth, all proclaiming their modern, progressive bona fides by embracing diversity, multiculturalism, and women’s rights. Even as it endorsed such progressive notions, the Clinton administration courted Wall Street” https://www.dissentmagazine.org/online_articles/progressive-neoliberalism- reactionary-populism-nancy-fraser Asylums, deinstitutionalisation and community care Deinstitutionalisation is a term that is used to describe the policy of the closure of large, long stay mental health hospitals. This is a policy that has been followed across the world. It is often seen as a mark of progress or a move towards more humane treatment of the mentally ill. Community care is a phrase that does not appear in many contemporary mental health policy documents. It seems to have disappeared. One possible explanation is that the main tenets of community care are so deeply entrenched in services that there is no need to make statements in support of it. This is a rather limited, naive analysis. Mental health services have become the sites of increasing bureaucracy and managerialism which stifle the idealism that underpin the initial support for deinstitutionalisation and community care (Cummins, 2019). Asylum One way of understanding the development of community care is to see it as a response to the failings of the asylum regime. The asylum is situated physically apart from the wider community (Rogers and Pilgrim, 2014). This physical distancing, subsequently,